Planteamiento del Manual de Gestión Ambiental

A. Program physicians shall review, approve and document in patient records all take-home doses along with written evaluation of patient responsibility in handling opioid drugs.

B. Take-home doses of methadone three times per week (Step Level I) may be approved after at least three (3) months of treatment during which compliance with the following minimum criteria has been demonstrated:

1. Last four (4) consecutive negative urine drug screen results; 2. No unexcused dose absences;

3. Adherence to program rules and take-home agreements; 4. Attending at least two (2) counseling sessions per month; 5. Following treatment plans;

home), or considered unemployable for mental or physical reasons by program physicians;

7. Absence of known recent criminal activity, as defined by the program; 8. No abuse of alcohol;

9. Capable of handling take-home bottles and behaving in a responsible manner and maintaining a stable living environment.

C. Take-home doses two (2) times per week (Step Level II) may be approved after at least two (2) years of treatment during which compliance with the following minimum criteria has been demonstrated: 1. Six (6) months of consecutive negative urine drug screen results;

2. No unexcused dose absences;

3. Adherence to clinic rules and take-home agreements; 4. Attending at least one (1) counseling session per month; 5. Following treatment plans;

6. Employed, attending school, homemaker (an individual who takes care of dependent(s) at home), or considered unemployable for mental or physical reasons by program physicians;

7. Absence of known recent criminal activity; 8. No abuse of alcohol;

9. Capable of handling take-home bottles and behaving in a responsible manner and maintaining a stable living environment.

D. Take-home doses one (1) time per week (Step Level III) may be approved after three (3) years of treatment during which compliance with the following minimum criteria has been demonstrated: 1. Last twelve (12) months of consecutive negative urine drug screen results;

2. No unexcused dose absences;

3. Adherence to program rules and take-home agreements; 4. Attending at least one (1) counseling session per month; 5. Following treatment plans;

6. Employed, attending school, homemaker (an individual who takes care of dependent(s) at home), or considered unemployable for mental or physical reasons by program physicians;

7. Absence of known recent criminal activity; 8. No abuse of alcohol;

9. Capable of handling take-home bottles and behaving in a responsible manner and maintaining a stable living environment.

E. Take-home agreements shall be developed and implemented for patients approved for take-homes. Agreements shall be part of the treatment plan and specify the rationale for take-home step levels, doses, frequency of step level changes and consequences for violating conditions of the agreement.

F. Take-home methadone doses shall be dispensed in a medication container conforming to State and Federal Poison Prevention Packaging requirements, with the following labeling affixed:

1. Program name, address, and telephone number; 2. Patient names;

3. Drug type;

4. Quantity, if not a physician-authorized blind dose; 5. Directions for use.

G. Positive urine drug screens for patients at Step Level I shall result in a reduction of step level status to Daily Status for a period of thirty (30) calendar days.

1. If urine drug screen results are acceptable during this probationary period, patients may return to Step Level I.

2. Positive urine drug screen results during the probationary period shall result in patients having to re-earn step level privileges as defined in Section 9.6, B.

H. Positive urine drug screen results for patients at Step Level II shall result in a reduction of step level status from Step Level II to Step Level I for a period of thirty (30) calendar days.

1. If urine drug screen results are acceptable during this probationary period, patients may return to Step Level II.

2. Positive urine drug screen results during this probationary period shall result in a reduction of step level status from Step Level I to Daily Status for a period of thirty (30) calendar days. If urine drug screen results are acceptable during this second probationary period, patients may return to Step Level I for thirty (30) calendar days and then may return to Step Level II.

3. Positive urine drug screen during this second probationary period shall result in patients having to re-earn step level privileges as defined in Sections 9.6, B and C.

I. Positive urine drug screen results for patients at Step Level III shall result in a reduction of step level to Step Level II for a period of thirty (30) calendar days.

1. If urine drug screen results are acceptable during this probationary period, patients may return to Step Level III.

2. Positive urine drug screen results during this probationary period shall result in a reduction of step level status to Step Level I for a period of thirty (30) days. If urine drug screen results are acceptable during the second probationary period, patients may return to Step Level II for thirty (30) calendar days prior to resuming Step Level III.

3. Positive urine drug screen results during this second probationary period shall result in a reduction of step level status to Daily Status for a period of thirty (30) calendar days. If urine drug screen results are acceptable during this third probationary period, patients may return to Step Level I for thirty (30) calendar days, followed by Step Level II for thirty (30) calendar days prior to resuming Step Level III.

4. Positive urine drug screen results during this third probationary period shall result in patients having to re-earn step level privileges as defined in Sections 9.6, B, C, and D.

J. During a probationary period, urine drug screens shall be collected and analyzed on a random basis of two (2) times per month.

K. Unexcused absences or missed scheduled appointments for patients with step level privileges shall result in reductions of step level status for a period of ninety (90) calendar days. In order to resume step level status, there shall be three (3) consecutive months of urine drug screens that are acceptable and that have been analyzed on samples collected with a frequency of two (2) times each month.

L. Prior to dispensing take-home medications, programs shall submit and obtain ADAD approval for the following:

1. All doses in excess of 101 milligrams per daily dose; 2. Split doses;

3. Take-home medication provided during detoxification treatment of less than thirty (30) calendar days;

4. Take-home medication doses that exceed seven (7) calendar days;

5. Take-home medication doses that do not meet the criteria as defined in Section 9.6, B, C, and D;

6. Take-home medication doses for patients with unacceptable urine drug screen results within the last ninety (90) calendar days.

9.7 Prescribing, Dispensing, and Administering Methadone, LAAM, or Other Approved Controlled